The Journal of Bone and Joint Surgery (American). 2008;90:1258-1264.
doi:10.2106/JBJS.G.00853
© 2008 The Journal of Bone and Joint Surgery, Inc.
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The Epidemiology of Neonatal Brachial Plexus Palsy in the United States

Susan L. Foad, MPH1, Charles T. Mehlman, DO, MPH1 and Jun Ying, PhD2

1 Division of Pediatric Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2017, Cincinnati, OH 45229. E-mail address for S.L. Foad: Susan.foad{at}cchmc.org. E-mail address for C.T. Mehlman: Charles.mehlman{at}cchmc.org
2 Division of General Internal Medicine, Department of Internal Medicine, University of Cincinnati College of Medicine, Institute for the Study of Health, P.O. Box 670840, Cincinnati, OH 45267-0840. E-mail address: yingj{at}ucmail.uc.edu
Investigation performed at the Division of Pediatric Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, and the Division of General Internal Medicine, Department of Internal Medicine, University of Cincinnati College of Medicine, Institute for the Study of Health, Cincinnati, Ohio

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from the University of Cincinnati Orthopaedic Research and Education Fund. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: The nationwide incidence of neonatal brachial plexus palsy in the United States is unknown. The purpose of this study was to determine the incidence of this condition in the United States and to identify potential risk factors for neonatal brachial plexus palsy.

Methods: Data from the 1997, 2000, and 2003 Kids' Inpatient Database data sets were utilized for this study. Patients were identified with use of the International Classification of Diseases, Ninth Revision (ICD-9), code 767.6 for neonatal brachial plexus palsy. Previously reported risk factors for this condition, including shoulder dystocia, instrumented delivery, breech delivery, an exceptionally large baby (>4.5 kg), heavy infant weight for gestational dates, multiple birth mates, and cesarean delivery, were also identified with use of ICD-9 codes. Multivariate logistic regression analysis was utilized to assess the association of neonatal brachial plexus palsy with its risk factors, after adjusting for sociodemographic characteristics, such as gender, race, and payer status; hospital-based characteristics, such as number of hospital beds, hospital location, region, type, and teaching status; and the effect of time.

Results: Over eleven million births were recorded in the database, and 17,334 had a documented brachial plexus injury in the total of three years, yielding a nationwide mean and standard error of incidence of neonatal brachial plexus palsy in the United States of at least 1.51 ± 0.02 cases per 1000 live births. The incidence of this condition has shown a significant decrease over the years (p < 0.01). In the multivariate analysis, shoulder dystocia had a 100 times greater risk, an exceptionally large baby (>4.5 kg) had a fourteen times greater risk, and forceps delivery had a nine times greater risk for injury. Having a twin or multiple birth mates and delivery by cesarean section had a protective effect against the occurrence of neonatal brachial plexus palsy. Forty-six percent of all children with neonatal brachial plexus palsy had one or more known risk factors, and fifty-four percent had no known risk factors.

Conclusions: This nationwide study of neonatal brachial plexus palsy in the United States demonstrates a decreasing incidence over time. Shoulder dystocia poses the greatest risk for brachial plexus injury, and having a twin or multiple birth mates and delivery by cesarean section are associated with a protective effect against injury. Most children with neonatal brachial plexus palsy did not have known risk factors.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.


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Causes and Factors Involved In Neonatal Brachial Plexus Palsy
Israel Alfonso, et al.
JBJS Online, 26 Aug 2008 [Full text]